sion in the flank, between the rib and the hip, and muscle dilation instead
of dissection in order to reach and remove the damaged disc and implant
the graft material and fixation device. Advances in neuromonitoring help
us to identify and avoid injury to nerve bundles on the way to the spine.
Because the patient must be on his side to facilitate this approach, an
OR table that can securely support this positioning is essential. Spine
specialty tables are one option, but general-use tables will also serve,
as long as they're constructed from radiolucent materials and allow
the intraoperative positioning of C-arms or other fluoroscopic imaging
equipment.
Endoscopic access
As a solution to lower back or neck pain, spinal fusion is a bit of a trade-
off. When we graft and fixate vertebrae to heal into a single, solid bone,
those levels are not able to move independently anymore. Implanting arti-
ficial disc implants, on the other hand, repairs painful vertebrae while
preserving spinal motion. They may also provide an option in the event
that fusion is unsuccessful or painful. While a couple of manufacturers
have been offering artificial discs for about a decade, the recent FDA
approval of Aesculap's activL, the first new entry in the field since then,
may boost interest in this option.
Considering the revolutionary, indispensable role that endoscopy
now plays in abdominal and orthopedic surgery, you would hardly
expect that it wouldn't find an application in spine surgery.
Endoscopic discectomy, for example, hasn't yet caught on with the
same widespread use as laparoscopic cholecystectomy or arthroscop-
ic meniscectomy, but it offers advantages over open and even micro-
scopic visualization.
The approach is similar to that of single-port access, and uses simi-
lar technology. Once the site is targeted, a cannula provides entry for
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